IRENE BALLESTEROS.- When making a Value-Based Public Purchasing (CPBV) In the health sector, health results should be the most relevant indicator, however, it is the most complicated to implement. This is stated by the majority of the 50 health managers who have participated in a probe carried out by the Spanish Society of Health Directors (Sedisa), with the collaboration of the PRIM Group, where 24% of the participants were nurses and doctors, among other health professionals. Even though he 62% of respondents believe that health outcomes It is the indicator that should have the most weight, those who carry out the CPBV admit that efficiency is the most used criterion.
To achieve a CPBV designed in the patient well-beingcollaboration is necessary between all the actors involved, which are public administration, technology industry, health professionals and patients. Thus, in the presentation of the results of the survey, three pioneering and benchmark experienceswhich are presented as comprehensive management solutions and become the starting point for making a public purchase taking into account factors and indicators designed for the patient’s well-being.
One of them has been the nursing management of diabetic foot at the Puerta de Hierro University Hospital in Madrid. A pioneering and benchmark experience presented by Almudena Santano, former Director of Nursing at the Puerta de Hierro Hospital and current manager of the Infanta Cristina University Hospital. A transversal project that offers a global solution to the approach to this pathology, which is at the origin of five out of every six amputations that occur in the foot. patients with diabetes. 40% of diabetic foot injuries can be avoided with a early diagnosis and treatment.
«The ulcer is one of the most serious complications of this disease. The WHO estimates that every 30 seconds some leg is lost in the world for this reason. In fact, the mortality after amputation in these cases it can be compared to many cancers. Therefore, our proposal has been to create a Diabetic Foot Unit in the hospital, to address this management and work on reducing this rate of amputations. It is an innovation project, a value proposition for patients, in which we work with health outcome indicators. We want to involve all areas of care, but also the Primary Careand of course, also to the patients themselves as a fundamental element,” says Santano.
Ankle ulcer. Author: Bobjgalindo
«The nurses know the patient’s situation very well, but we must give the patient the opportunity to express how they feel and we have to do that with them, taking into account what worries them in their care process, and that’s going to incorporate those social values in purchasing«explains Susana Álvarez, deputy director of Medical Inspection and Evaluation in the General Directorate of Inspection and Health Regulation of the Madrid Health Department.
In this project they have included the CPBV as an essential element to assess the financing possibilities and the capacity for transformation of the unit. «We had no experience in this area. But we saw that the CPBV could be a fundamental part of our unit, since it is estimated that the direct cost of a major amputation is around €20,000 and the indirect costs are multiplied by five after three years. We saw that this CPBV had to be linked to the object of the contract, be based on an objective manner with respect to the principles of equality, non-discrimination, but also with those specifications that seek the result of product quality, sustainability in line with the objectives of sustainable developmentsocial characteristics in technical assistance with real purchasing solutions that we could incorporate into the process, telemedicine solutionsinvolve the patient and even increase research,” he continues.
The truth is that the value sought in purchasing processes They do not always match those sought in the clinic. «There is a difficult situation and this was one of the challenges we faced, in which we have the biggest obstacle when it comes to implementing it. The truth is that we do not have enough information or training in this regard, but our aim “It is incorporating the impact on the patient and the financial analysis and not just acquiring services or solutions,” says the manager.
The concept of Value-Based Management is based on “an approach that takes into account not only economic aspects, but also other less tangible, but crucial for health results, such as improving the quality of life of patients or avoiding indirect costs in public purchases,” concludes Fernando Oliveros, executive advisor of PRIM.